Coaching with Anita - Application Form
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Email *
Name and surname *
Date (DD.MM.YYYY), time (HH:MM) and place of birth. *
(l will use this to see how you work best according to Human Design )
Phone number *
Why do you plan to work with a coach? *
Did you ever work 1:1 with a coach before? *
Fill in if you your response to previous Q was "Yes": What did you like about your coaching and what not? What would you need more/less of?
Where do you see yourself one year from now?
What do you want to create? What are your long term goals? What do you see as worthy of your investment of time-energy-love-money? What is the thing that will make you completely satisfied on your death bed that you invested your life in it? *
How far are you on your journey of creating what you really want in your life? *
I don't even know what I want.
I am on my way, moving every day.
What steps did you already take in the direction of your dreams? *
How committed are you to following through with your vision? *
I usually quit very fast.
I am 100% committed, nothing can stop me.
How will coaching help you with that? What are your intentions? How will you make the best use of our time together? *
What usually comes between you and your dreams? Where do you have most of your pain points? *
What is your favourite way of sabotaging yourself? (Procrastination, analysis paralysis, finding a problem for every solution before even trying it out, creating drama in relationships, over-giving and burning out, isolating yourself, serial health problems, blaming others instead of looking for solutions, not seeing a point anymore, quitting...) *
How willing are you to overcome your self sabotaging patterns of behaviour? *
This is just the way I am, I cannot change that.
Very committed. I love testing out new ways of being and doing. Those that I enjoy soon become my good habits.
Which coaching package you are most interested in?
(You can find the packages here:
Why did you choose this package? 
Where it will serve you the most? 
How will you make the best use of it?
How much are you currently willing and capable to invest in coaching and personal growth? *
What insights about yourself did you have while filling in this application form? *
Is there anything else you would like me to know?
A copy of your responses will be emailed to the address you provided.
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